Uso do verde de indocianina na prevenção de fístula anastomótica em cirurgias colorretais: uma revisão sistemática

Anastomotic leak is a serious complication in colorectal surgery, with an incidence of up to 19% and significant mortality. Indocyanine green (ICG) allows intraoperative assessment of bowel perfusion through fluorescence imaging, but its effectiveness in reducing leaks remains controversial. This systematic review aimed to evaluate whether ICG use reduces anastomotic leak rates in colorectal surgery compared to conventional visual inspection. The search was performed in PubMed using MeSH terms, identifying 198 articles. After applying inclusion and exclusion criteria, 7 randomized controlled trials were analyzed. Two studies demonstrated significant leak reduction with ICG (Alekseev et al., 2020: 16.3% vs 9.1%, p=0.04; Watanabe et al., 2023: 11.8% vs 7.6%, p=0.041), while five studies showed no statistically significant difference, although with a numerical trend favoring ICG. Subgroup analyses suggest ICG benefit in low anastomoses (rectal). No serious adverse events were reported. ICG is safe, but its clinical efficacy remains uncertain. Routine use for all colorectal surgeries is not recommended, although it may be promising in high-risk scenarios, such as low rectal surgery.